Bisphosphonate-related osteonecrosis of jaws and the relationship with actinomyces organisms

Abstract

<h3>Background</h3> Actinomyces species are part of the normal oral flora. They may also be found in association with non-vital bony sequestra in suppurative osteomyelitis, osteoradionecrosis and bisphosphonate-related osteonecrosis of jaws (BRONJ). <h3>Methods</h3> Sixty-two cases of histologically diagnosed chronic suppurative osteomyelitis affecting the jawbones were retrieved from the archives at the ICPMR, Westmead Hospital. The haematoxylin and eosin-stained slides and the available clinical notes were reviewed. <h3>Results</h3> In 23 cases, a history of bisphosphonate use was established. Most cases presented in elderly females and the mandible was the most commonly affected site. Bacterial colonies with the morphological appearance of Actinomyces species were identified in 12 cases diagnosed as BRONJ (12 of 23 cases) while only four cases of non-specific suppurative osteomyelitis demonstrated these organisms (4 of 34 cases). The remaining five cases were diagnosed as osteoradionecrosis. <h3>Discussion</h3> Cervico-facial actinomycosis is a chronic bacterial infection of the soft tissue and jaws caused by the saprophytic Gram-positive, anaerobic bacteria Actinomyces species. In this study, Actinomyces species were frequently associated with BRONJ. As in cervico-facial actinomycosis, long-term use of an appropriate antibiotic, such as penicillin, may play a role in improving the outcome for these patients.